巴基斯坦住院急性呼吸道感染儿科患者的抗生素处方实践与错误：一项多中心横断面研究
Antibiotic Prescribing Practices and Errors among Hospitalized Pediatric Patients Suffering from Acute Respiratory Tract Infections: A Multicenter, Cross-Sectional Study in Pakistan.
作者信息
Iftikhar Sadia, Sarwar Muhammad Rehan, Saqib Anum, Sarfraz Muhammad, Shoaib Qurat-Ul-Ain
机构信息
Akhtar Saeed College of Pharmaceutical Sciences, Lahore 54000, Pakistan.
Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur 63100, Punjab, Pakistan.
出版信息
Medicina (Kaunas). 2019 Feb 11;55(2):44. doi: 10.3390/medicina55020044.
The noncompliance of treatment guidelines by healthcare professionals, along with physiological variations, makes the pediatric population more prone to antibiotic prescribing errors. The present study aims to evaluate the prescribing practices and errors of the most frequently prescribed antibiotics among pediatric patients suffering from acute respiratory tract infections who had different lengths of stay (LOS) in public hospitals. Methods: A retrospective, cross-sectional study was conducted in five tertiary-care public hospitals of Lahore, Pakistan, between 1 January 2017 and 30 June 2017. The study population consisted of pediatric inpatients aged 0 to 9 years. Among the 11,892 pediatric inpatients, 82.8% were suffering from lower acute respiratory tract infections and had long LOS (53.1%) in hospital. Penicillins (52.4%), cephalosporins (16.8%), and macrolides (8.9%) were the most frequently prescribed antibiotics. Overall, 40.8% of the cases had antibiotic prescribing errors related to wrong dose (19.9%), wrong frequency (18.9%), and duplicate therapy (18.1%). Most of these errors were found in the records of patients who had long LOS in hospital (53.1%). Logistic regression analysis revealed that the odds of prescribing errors were lower in female patients (OR = 0.6, 95% CI = 0.1⁻0.9, -value = 0.012). Patients who were prescribed with ≥3 antibiotics per prescription (OR = 1.724, 95% CI = 1.1⁻2.1, -value = 0.020), had long LOS (OR = 12.5, 95% CI = 10.1⁻17.6, -value < 0.001), and were suffering from upper respiratory tract infections (URTI) (OR = 2.8, 95% CI = 1.7⁻3.9, -value < 0.001) were more likely to experience prescribing errors. Antibiotics were commonly prescribed to patients who had long LOS. Prescribing errors (wrong dose, wrong frequency, and duplicate therapy) were commonly found in cases of lower respiratory tract infections (LRTIs), especially among those who had prolonged stay in hospital.
医护人员不遵守治疗指南，再加上生理差异，使得儿科人群更容易出现抗生素处方错误。本研究旨在评估在公立医院住院时间长短不同的急性呼吸道感染儿科患者中，最常开具的抗生素的处方行为和错误情况。方法：2017年1月1日至2017年6月30日期间，在巴基斯坦拉合尔的五家三级医疗公立医院开展了一项回顾性横断面研究。研究人群包括0至9岁的儿科住院患者。在11892名儿科住院患者中，82.8%患有下呼吸道急性感染，且住院时间长（占53.1%）。青霉素（52.4%）、头孢菌素（16.8%）和大环内酯类（8.9%）是最常开具的抗生素。总体而言，40.8%的病例存在与错误剂量（19.9%）、错误频次（18.9%）和重复治疗（18.1%）相关的抗生素处方错误。这些错误大多出现在住院时间长的患者（占53.1%）的记录中。逻辑回归分析显示，女性患者出现处方错误的几率较低（比值比=0.6，95%置信区间=0.1至0.9，P值=0.012）。每次处方开具≥3种抗生素的患者（比值比=1.724，95%置信区间=1.1至2.1，P值=0.020）、住院时间长的患者（比值比=12.5，95%置信区间=10.1至17.6，P值<0.001）以及患有上呼吸道感染（URTI）的患者（比值比=2.8，95%置信区间=1.7至3.9，P值<0.001）更有可能出现处方错误。抗生素通常开给住院时间长的患者。处方错误（错误剂量、错误频次和重复治疗）常见于下呼吸道感染（LRTIs）病例中，尤其是那些住院时间延长的患者。
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